Cancer in African Americans: Gap closing for some sites, widening for others

The cancer death rate for men declined faster among African Americans than among whites in the latest time period, narrowing the racial disparity in overall cancer death rates, according to a new report from the American Cancer Society. But while gaps are closing for some cancers, such as lung and other smoking-related cancers and for prostate cancer, the racial disparity has widened for colorectal cancer and female breast cancer, cancers that are most affected by screening and treatment. The findings are published in Cancer Statistics for African Americans, 2013 which appears in CA: A Cancer Journal for Clinicians. The report and its consumer version, Cancer Facts & Figures for African Americans 2013-2014, provide current data on cancer incidence, mortality, survival, screening test use, and risk factors for African Americans.

The decrease in overall cancer death rates among African American males was the largest of any racial or ethnic group during the most recent time period. The reduction in overall cancer death rates since the early 1990s translates to the avoidance of nearly 200,000 deaths from cancer among African Americans.

Meanwhile, five-year relative survival rates are lower for African Americans than whites for most cancers at each stage of diagnosis. "These disparities largely reflect unequal access to health care and other socioeconomic factors," said Otis W. Brawley. M.D., American Cancer Society chief medical officer. "While cancer death rates among African American men have been declining rapidly, they remain 33% higher than those among white men, evidence that more can and should be done to accelerate this progress by making sure all Americans have equal access to cancer prevention, early detection, and state-of-the-art treatments."

The report finds that from 2000 to 2009, the overall cancer death rate declined faster among African American males than white males (2.4% vs. 1.7% per year), but similarly among females of both races (1.5% and 1.4% per year, respectively). Other findings from the report:

About 176,620 new cancer cases and 64,880 cancer deaths are expected among African Americans in 2013.

The most commonly diagnosed cancers among African American men are prostate (37% of all cancers), lung (14%), and colon and rectum (10%).

Among African American women, the most common cancers are breast (33% of all cancers), lung (13%), and colon and rectum (11%).

African American males have higher incidence rates than whites for all cancers combined (15% higher) and for the most common cancers (including prostate, lung, colorectal, kidney, and pancreas).

African American females have lower overall incidence rates than whites for all cancers combined (6% lower) and for many cancers, including the two most common: breast and lung.

Cancer death rates remain 33% higher among African American men than white men, despite the larger declines among African American men in the most recent time period.

The cancer death rate among African American women is 16% higher than that among white women, despite a 6% lower cancer incidence rate.

The higher overall cancer death rates among African Americans compared to whites is due largely to higher death rates for cancers of the breast and colorectum in women and for cancers of the prostate, lung and bronchus, and colorectum in men.

The disparity in lung cancer death rates between African American and white men has been reduced by half overall (from an excess of 50% in 1990-1992 to 26% in 2005-2009) and has been eliminated in adults younger than age 40, likely reflecting faster declines in smoking prevalence among African Americans compared to whites.

African American men have historically had higher smoking prevalence than white men, though in recent years the rates have converged. African American women have generally had slightly lower smoking prevalence than white women over the past two decades.

Smoking prevalence among high school students is markedly lower among African Americans than whites. As of 2011, 14% of African American high school boys and 7% of African American girls smoked cigarettes, compared to 22% of white boys and 19% of white girls.

Despite similar mammography screening rates, only about half (51%) of breast cancers diagnosed among African American women are diagnosed at a local stage, compared with 61% among white women. The difference has been largely attributed to a lower frequency of and longer intervals between mammograms, and a lack of timely follow-up of suspicious results.

Incidence rates for colorectal cancer are 23% higher in African American men and 22% higher in African American women compared with white men and women, respectively, and death rates are 53% higher in African American men and 46% higher in African American women, reflecting differences in risk factors, screening, and treatment. In 2010, 56% of African Americans aged 50 and older were up to date on guideline-recommended colorectal screening compared with 62% of whites.

Overweight and obesity are more common among African American women and girls than white women and girls, while there is less racial disparity among men and boys. Fifty-nine percent of African American women and 25% of African American girls are obese compared to 33% of white women and 15% of white girls.

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